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					  JULY 18, 1936                                  ENGLANP AND WALES                                         M THEBRMTIg S 149
Society of Medicine, the Medical Society of London, the           professor of midwifery. In 1912 he was appointed regius
Society of Apothecaries, and the Hunterian, Harveian,             professor of midwifery, and for many years was physician
and Chelsea Clinical Societies. The toast was-responded           to the Maternity Hospital and gynaecologist to the Royal
to by Mr. H. L. Eason, Vice-Chancellor of the University          Infirmary. Professor Theodore Shennan was pathologist
of London, and by Dr. Robert Hutchison, president of the          to the Royal Infirmary of Edinburgh and lecturer in
Royal Society of Medicine, who said that he was glad his          pathology and bacteriology in the school of medicine of
society had not swallowed all the smaller ones, because           the Royal Colleges at Edinburgh for a number of years,
he believed the smaller medical societies had a distinct          but for the last twenty-two years he has been regius
function. The members knew each other better, and the             professor of pathology in Aberdeen.
politeness which so cramped the style of discussion in the
larger societies had a less inhibiting influence in the smaller                    New Hospital at Paisley
bodies. Among these smaller societies the West London                A new hospital for infectious diseases at Paisley, which
was a model.                                                      has cost approximately £150,000, was opened on July 7th.
                                                                  This hospital, which stands on the main Hawkhead road,
               Psychotherapy and the Church                       will provide accommodation for over 180 patients, and
   A circular letter signed by the Archbishop of York as          c6nsists of seven pavilions. One of the pavilions is a
chairman, and Canon J. F. L. Southam of Chester and               cubicle block with accommodation for thirty patients, and
Canon F. Paton-Williams of Manchester as joint secre-             is designed for isolating doubtful cases. Others are in-
taries, states that an opportunity has arisen to promote          tended for pneumonia (thirty beds), diphtheria (twenty-
the co-operation of the clergy (and church people generally)      one beds), scarlet fever (thirty beds), measles (twenty
with medical psychologists (and the medical profession            beds), whooping-cough (twenty beds), and tuberculosis
generally).                                                       (thirty beds). The pavilions are single-story buildings
   " The practice of psychotherapy has developed greatly in       with verandas and a solarium. In the nurses' hlome
recent years, and is bound to play an increasing part in the      forty-nine nurses and six sisters will be accommodated,
treatment of those suffering from the varous forms of disease     and the administrative block, in addition to dining and
-mental and otherwise-which are caused in whole or in             sitting rooms, contains rooms for the matron, medical
part by psychical conditions. It is evident that medical work     officers. and maids.
of this kind comes into very close relations with some parts
of the pastoral work of the clergy, and co-operation betwNeen
clergy and medical psychologists is greatly to be desired.                        CORRESPONDENCE
Also it is evident that the practice of psychotherapy involves
action to which the principles of the Christian religion and                             Poliomyelitis
ethics are directly relevant; if these are neglected great harm
may result. "                                                        SIR,-In his interesting paper on epidemic polio-
   Accordingly Miss Graham Ikin, a psychologist, has              myelitis, Sir Arthur MacNalty pays me the compliment
been entrusted with a mission to give lectures, to lead           of citing a classification of the pathological and clinical
conferences, or to meet individuals with a view to spread-        events in this disease that was formulated by me some
ing that understanding of the subject which is needed as          nine years ago.
a preliminary to co-operation. She will not herself prac-            At the time it was made this classification was an
tise as a lay psychotherapist, but will aim at bringing           acceptable generalization of the state of our knowledge.
together those who practise psychotherapy and those who           In the history of poliomyelitis research nine years is a
as pastors give spiritual guidance. Among those support-          long time, and no one wouId now accept this generaliza-
ing the enterprise are the Bishops of Bradford and Man-
chester ; Dr. J. R. Rees, director of the Institute of            tion a-s in accord with what we have since learned of the
Medical Psychology; and Dr. H. P. Newsholme, M.O.H.,              nature of poliomyelitis from the work of Weston Hurst
Birmingham. The medical members of the committee to               and Farebrother in this country and that of others in
which Miss Ikin will be responsible are Professor John            America and Germany.
Hay, Dr. Neil Macleod, Dr. T. WV. Mitchell, and Professor            A conception of poliomyelitis as a virus infection of the
Maxwell Tellingr.                                                 nervous system exclusively is now generally accepted.
                                                                  The clinical and pathological evidence upon which the
                                                                  belief in an initial stage of generalized systemic infection
                       Scotland                                   was based is now thought to require and to be capable of
                                                                  another interpretation.
                New Edinburgh Professors                             A summary of this new conception and a discussion of
The University Court of the University of Edinburgh               its bearings upon treatment were submitted by me three
has transferred Professor D. Murray Lyon from the                 years ago at the Annual Meeting of the Association in
Christison chair of therapeutics in the University of             Dublin, and it is by this summary that I should prefer
Edinburgh to the Moncrieff Arnott chair of clinical medi-         to be cited rather than by views formulated at a com-
cine, to be vacated by Professor Edwin Matthew on                 paratively remote epoch and now completely obsolete.
September 30th next. It is understood that in future the          The Dublin paper was published in this Journal on
professor of clinical medicine will be relieved from duties       December 30th, 1933.-I am, etc.,
in the Royal Infirmary of Edinburgh and will be trans-              London, W.1, July 11th.              F. M. R. WALSHE.
ferred to the Western General Municipal Hospital. To fill
the vacancy thus created in the chair of therapeutics, the
University Court has appointed Dr. Derrick Melville                            Epidemic Nausea and Vomiting
Dunlop, who is at present one of the assistant physicians
to the Royal Infirmary. Dr. Dunlop, who graduated                   SIR,-An epidemic of vomiting occurred in one bf the
M.B., Ch.B. at Edinburgh in 1926 and M.D. in 1927, is             school camps in South Wales, with symptoms closely
also lecturer on therapeutics and assistant to the professor      resembling those described by Drs. R. Miller and M.
of tuberculosis in Edinburgh University.                          Raven in their communication to the Jouxnal of June 20th
           Aberdeen Professorial Resignations                     (p. 1242).
  At a meeting of the Aberdeen University Court on                   The first case was seen at the camp surgery on Sunday,
July 10th the resignations of Professor Robert Gordon             May 31st, wvhen I was present. A boy came to see the
M'Kerron from the chair of midwifery and of Professor             nurse on account of abdominal pain, and very shortly after-
Theodore Shennan from the chair of pathology were                 wards, about 4.30 p..m., had violent vomiting. A few minutes
announced. Professor M'Kerron joined the teaching staff           later, wthen I saw hiim, he appeared to have greatly improved,
of Aberdeen University in 1891 as assistant to the                but he was kept in one of the isolation cubicles for the night,
professor of physiology, and was later assistant to the           so as to be under the supervision of the niurse. During the
   150 JULY 18, 1936                                                                   CORRESPONDENCE                                                       MEDICAL IOURNAL
 next few days more cases of vomiting occurred, the highest                                          and infection from the water supply was therefore ruled out.
 number being on June 2nd, when five teachers and thirty-                                            Grade A (T.T.) milk was consumed, either raw or cooked,
 seven boys were affected. In all, eight teachers and fifty                                          by all in the camp. I obtained a sample of the milk for
 boys were concerned.                                                                                examination at the Beck Laboratory, Swansea. I also took
   The total number ot teachers was seventeen, the boys                                              a specimen of vomited matter for examination at that labora-
 numbering 187. Thirty-three boys, with three teachers,                                              tory, and further specimens of vomited matter and of faeces
 occupied each of five huts. Hut D was occupied by twenty-                                           were sent on June 4th.
 two boys and two teachers. (A third of this hut is par-                                                The permanent staff, consisting of seven persons, were not
 titioned off to provide for surgery, isolation cubicles, and                                        affected in this outbreak, but the senior cook had suffered
 nurse's bedroom.) The following table shows the distribution                                        from an attack of diarrhoea of short duration on May 30tlh.
 of the cases in the six huts, with the number of teachers                                           He had quite recovered from this by the next morning and
 and boys affected each day.                                                                         was on duty as usual, the state of the bowels having become
                                                                                                     normal. When I visited the camp on June 3rd I gave instruc-
    Huts         A            B            C            D         E            F        All Hiits    tions that during the next week he must not handle any
                                                                                                     raw foodstuffs-meat, milk, vegetables, etc. These instruc-
             T. B. T. B. T. B. T. B. T. B. T. B.                                        T.    B.     tions were given on the assumption that he might have been
                                                                                                     the source of the outbreak.
 May 31st    - ---    1   ..                                                                   1        The following report of Dr. Sladden, Beck Laboratory,
                                                                                                     Swansea, gives the result of his examinations:
 June lst    - 5 2 - - --    1 3 _                                       8              3              Milk Supply.-Milk count entirely satisfactory, of " certi-
      2nd    1 8 1 5 214   -  3 1 6                                   5 37                          fied " standard. Special cultures showed no food-poisoning
      3rd    -.1                                                  ..-- -1                            bacteria or other bacteria likely to cause gastritis, except a
                                                                                                     few staphylococci, in fluid media only.
    ,4th     - -          -           --        3            ..                                3        Vomits.-Boy, B. B., June 2nd: Chemical and micro-
      5Eth           ---          -    -       -    -         -       -   --                         scopical    examination-normal;       bacteriological-negative
                                                                                                    results. R. W. C., D. E., and H. M.: All negative bacterio-
             1       13   3       5    2       18       -2    1       6   1        6    8     50    logically.
                                                                                                       Faeces. D. E. and T. D. W.: No evidence of colitis or
     The following notes relate to eight teachers and forty-seven                                   of infection by food-poisoning bacteria.
  boys, who came for a two-weeks stay at the camp on                                                   Conclusions.This milk supply is satisfactory, but an
  May 22nd. No complete information was obtained in the case                                        earlier supply may have become contaminated at the camp.
  of three boys who vomited on June 4th, the day before they                                        Absence of enteritis or colitis, and very rapid recovery, is
  left the camp. Inquiry showed that the principal symptoms                                         against Salmonella infection as a cause, and there is no
  before an attack oi vomiting were: abdominal pain (thirty                                         bacteriological evidence of this. The history suggests trans-
                                                                                                    mission of a bacterial infection on May 30th by the cook
  cases); chilly sensations (twenty-seven cases); headache                                          to the milk supply, the infection being possibly staphylococcal,
  (eighteen cases); giddiness (fourteen cases); nausea (nine                                        producing toxins and gastritis but not progressing into the
 cases); diarrhoea (seven cases); the last two symptoms mainly                                      intestines. These examinations, however, bring no satisfactory
  affecting the teachers (nausea in seven and diarrhoea in six).                                    evidence to support this theory.
  In no case was there any rise of temperature. In five cases
  (two teachers and three boys) there was no vomiting, but                                          -I am, etc.,
 nausea was complained of. Vomiting occurred once in twenty-                                                                                         L. W. POLE,
  six cases; twice in seventeen cases; three times in five boys                                       Llanelly, July 10th.                      Med-ical Officer of Health.
 four times in two boys. Vomiting came on suddenly, oftenl
 without any warning. In ten cases the amount of vomited
 material was small, but in the other cases it was copious. In                                          Mortality and Phthisis in Mental Hospitals
 thirty-seven cases the vomited material was undigested stew,                                         SIR,-A study of the incidence of tuberculosis in sub-
 which had been eaten at dinner-time (1 p.m.) on the same
 day.     In thirteen cases the vomited material was watery                                         normal groups is helpful in casting light on the aetiology
 and sometimes yellowish.                                                                           of the disease. The contention that the existence of
     In one case vomiting was at 10 a.m. three boys vomited                                         tuberculosis among patients in mental institutions is re-
 between 1.30 p.m. and tea-time (4.30 p.m.); but in the                                             lated to the twofold question of ventilation and diet, and
 majority of cases vomiting took place after tea and up till mid-                                   more especially to the latter, is supported by the increase
 night (thirty-five cases). In the early hours of the morning                                       in the death rate from this disease during the war years
 there were five cases. In all cases there was apparently com-                                      when the supply of food was depleted. In a communica-
 plete recovery in forty-eight hours, many feeling quite well                                       tion made in 1919 by Dr. Ashby Elkins and myself on
 within twenty-four hours and ready for meals. These were,                                          the death rate from tuberculosis, based chiefly on post-
 however, reduced in quantity.
    The principal symptoms complained of after an attack ol                                         mortem findings in a mental hospital during a period of
 vomiting were: abdominal pain (fourteen cases); headache                                           twenty years, the following figures were included:
 (seventeen cases); giddiness (fifteen cases); chilly sensations
 (twenty-seven cases). The appetite was good after an attack                                               veBPrage'ntS
                                                                                                        Year       Num
                                                                                                            verfag ie nt
                                                                                                                               eRthg
                                                                                                                                Death
                                                                                                                                    s
                                                                                                                                         flmMortality from Tuberculosis
                                                                                                                                         fr-o
 in twenty-one cases, fair in thirteen cases, and poor in seven-                                        Y a
                                                                                                         Yer
                                                                                                                  efsaidents
                                                                                                                           All Causes
 teen cases. The pulse was rather slow but regular, and the                                                         Resident                    ~~~~Deaths Rate per 1,030
 tongue was slightly coated in all cases. As a measure of
 precaution a dose of mist. alba was given to each 'patient,                                          1913          2,051          197                59            29.0
 but apart from this there was no treatment beyond some                                               1914          2,099          172               42             20.0
 restriction of diet already referred to. On the morning of
June 5th, when the boys and teachers were due to leave the                                            1915         2,045           240                70            34.2
 camp, the camp director reported that all were ready and fit                                         1916         2,041           283               102            49.9
for their journey- home.                                                                              1917         1,941           459               141            ,2.6
    When I visited the camp on May 31st no cases of vomitirig
had been reported, the first to be recorded being that of the                                         1918         1,769           542               2^8           117.6
boy who came to the camp surgery while I was there, and
who complained of abdominal pain, which was soon followed                                             In investigating the probable causes responsible for the
by a sudden attack of vomiting. Following a telephone cOn-                                          marked increase in the death rate given in the above
versation with the camp nurse on June 3rd I paid a visit
to the camp, as she reported that a large number of cases                                           table several points of special significance were noted.
of vomiting had occurred on the previous evening and during                                         The inmates included a large proportion of mental defec-
the early hours of Wednesday morning. No cases of vomliting                                         tives of low-grade type whose resistance to invasion by
had been reported as having occurred in the village near by,                                        the tubercle bacillus was far below norrhal, and whose

				
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